Well, I'm officially in the club now.

While low grade G6 is a good place to be, the AS controversy (and stress of being on the fence) is it's own issue. It'd almost be easier to decide if it were a 7.

I'm not concerned with AS leading to a grade 4 where its at, but I am concerned with any grade, even grade 3, spreading into stage 3. I'm also concerned with having a significant surgery that could leave me limp or pissing in a bag unnecessarily.

Gumby,

A formal AS program is absolutely NOT "rolling the dice". I certainly don't consider my eight years (so far) on AS to have been a "crapty place to be a patient". Knowing that I have avoided the often life-changing side effects of treatment, while being confident that my cancer is not threatening, is a great source of satisfaction to me.

Now, so far, you really don't have enough data to determine if AS is a correct long term course. You will need follow-up MRI's, a confirmatory biopsy, and one or several genomics tests, as well as other blood and urine tests to determine that you really belong in an AS program.

There are many offers of advice, both from practitioners and patients. Your dilemma of knowing what to trust is normal. Just keeping asking, and the information will keep coming. Good luck.

The doc's I consulted with during my time in your shoes ... even they all had different takes on, "If they were me..." what they'd do....with suprising results.

Dr. Partin, JH Prostate surgeon..."If it were me, I'd go downstairs and have seeds put in". When I told him the radiologists had already nixed that idea because pre-existing flow problems, it pizzed him off and said, "What a bunch of balogny! Can't have seeds in my own hospital!!"..... then proceeded to give me the names and numbers of radiologists around town to go see.

The radiologist that read my slides said...."If it were me, I'd leave it alone. I wouldn't want ANYBODY messin' with my prostate if it looked like this!"

My diagnosing Uro, upon giving me my biopsy results, had already enrolled me in his local AS program. "I've had cancer already. I'm not scared of this". One confirmatory blind 12 core biopsy at 12 mos. 3 mo. PSA checks. Then one blind biopsy every 3 years until age 70. That was the extent of it.

The RO I spoke with at UCLA told me...."I don't care what you do with it. Just treat it is all I care about. And soon!"

The head of the Oncology Dept. at Mt. Sinai laid out all options as being available to me. With one caveat....."No AS for you. You just don't have the personality for it".

Where you are....it's a crazy place to be. was for me anyhow. I cancelled one SBRT appt. and 2 or 3 sugeries. On one of them....I was all the way inside the operating room, laying on the table. Before they put me under....I left.

A part of me believes that, in the end, I may have chosen surgery just so I could be knocked out for the few hours it takes to operate....just to give my mind some rest from it all.

Surgery in Knoxville, TN. where I live. I travelled all over the country. Ended up doing it 5 miles from my house.

Your father-in-law.....that might very well be me. My PSA was high(ish) for 4 years before I ever even got a biopsy. Then...another year before the surgery. I really did not want to have anything done, at all. Not esp. AS! That's a great option for people who are not as afraid of "medical proceedures" as I am. I hate 'em. I hate 'em. I hate them. Period.

And I'm not alone. While I was doing my "due diligence", one guy who was a lurker here emailed me and said he had my same path.....and he was not going to treat it at all. He (like me) was somewhat of a loner. No family. 'Bout my age too. He was divorced. His wife had remarried and lived close by with her husband. They had remained friends....he'd go over on Sundays, sit on their porch, and visit. I liked that guy.

I don't advise letting nature take it's course. Just seems irresponsible. I was in denial. Learning about it all, travellin' around....in some weird way....I kinda enjoyed the process. But....the reality of doing it....man.....

Thank you for sharing.

So I had my consultation with the radiation oncologist today. Unfortunately he didn’t really make my choice any easier and wouldn’t recommend one treatment or another given my situation. He believes Active Surveillance, Radiation, and Surgery are all equal choices with their own varied consequences and it’s up to me.

Active surveillance: I’m low risk and I have time to decide and watching it wouldn’t be unreasonable. However because I’m young it could be difficult to watch, or predict long term and there is the risk of miscalculating and it becomes more aggressive than they thought and spreads. He also cautioned me that if my PSA were to hit 10, from a radiation perspective he would also recommend hormone treatment (my last PSA was 4.4 five months ago).

Radiation: He explained that the radiation options were seeding and beam. Seeding is a one time deal whereas beam is about 5 weeks straight, 5 days a week. He explained the slightly varied expectations of side effects between the two, and also compared to surgery and again said they were all about equal with the real difference being which the patient was more comfortable with – pick your poison essentially. He seemed to think waiting months, even a year of AS to test the waters was not unreasonable and that there was no emergency here, but his caution about the PSA hitting 10 to trigger hormone treatment seemed to suggest he wasn't recommending AS forever, but rather as a way to take my time and learn more and make the best treatment choice for myself.

He also did a DRE and said he did not feel anything as my primary Urologist did.

So in a couple weeks I meet with the surgical urologist for an RRP consultation and will see what he says. After that I will circle back with another recap consultation with my primary urologist for another consultation on all options since I’ll have more knowledge about everything at time. Then I have to make a choice. And in the case of prostate cancer I’ll quote the band RUSH “if you choose not to decide, you still have made a choice.”

Thanks. I wouldn't let it get that high either but based on my steady PSA rising over the years, even if my current doubling time remained consistent, I'm looking at a couple years tops before it gets there. My wife thinks I should AS for the next year and if it keeps going, hits the 6 range, then I should probably look at treating it. But I'm still investigating.

The only radiation options presented were IMRT and LDRBT. He also said that the LDRBT procedure is only done by one doctor in all of Southern California for my HMO and that doctor is in Los Angeles about 60 miles away so if I wanted more on that procedure I would need to consult with him. The oncologist I met with didn't say one would be better over the other, he said they both accomplish the same thing with the difference being the way they do it and really about personal patient preference. Right now I'm still looking at AS, surgery, or radiation in general. If I decided radiation looks better then I'll have to decide which one.

Hello all, I've been quiet for a while doing my research and visiting a couple different doctors including a surgeon and radiation oncologist. One thing I was waiting on was I had a Prolaris genome test done and I just got the results and they were not what I was expecting. The cells are considered aggressive scoring a 4.1 on a scale of 1-5 (best-worst)

Also my 6 month PSA jumped from 4.4 to 5.3 and continues the upward trend. So I'm in line for surgery now, expect that will be around August or maybe September. Well if anything I guess it forced me to make a decision as I was having a hard time with that.

The only thing that I'm confused about and didn't think of until afterwards was, the doctor emphasized that its still a slow moving cancer and there was no urgency to have the surgery tomorrow and that the expected time line of August/September was fine. How is aggressive also slow moving? I'm thinking that my Gleason 6 is where the cancer is now, and the genome just means it can evolve to something worse meaning AC is probably not a good choice.

I haven't seen my full report yet but here's a portion of a case study report that has a similar number to mine. It seems I'm at the lower end of the more aggressive bracket, closer to the consistent bracket than the considerably more aggressive, so I guess that's a silver lining.

VIEW IMAGE

Also it appears that the purpose of this test is to give an indication to doctors and patients who are low grade and unsure about the best treatment option an idea if the cancer is slower making Active Surveillance more viable, or if it's more aggressive and probably warrants treatment sooner (which I feel is the case for me.)